Evidence map›Paper›PMID 40736731›Full record

ArticleJAMA network open2025

State E-Cigarette Flavor Restrictions and Tobacco Product Use in Youths and Adults.

David Cheng, Boram Lee, Abra M Jeffers, Maeve Stover, Lindsay Kephart, Ginny Chadwick, Gina R Kruse, A Eden Evins, Nancy A Rigotti, Douglas E Levy

Abstract read
In one paragraph

Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Toxicity and Appeal of Flavoured E-Cigarettes and Flavour Ban Outcomes: A Narrative Review.International journal of environmental research and public health · 2026
    Review
  3. Article
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

David ChengBiostatistics Center, Massachusetts General Hospital, Boston.
Boram LeeEwha Womans University, Seoul, Republic of Korea.
Abra M JeffersMongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston.
Maeve StoverMongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston.
Lindsay KephartDepartment of Medicine, Harvard Medical School, Boston, Massachusetts.
Ginny ChadwickMongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston.
Gina R KruseDivision of General Internal Medicine, University of Colorado School of Medicine, Aurora.
A Eden EvinsCenter for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston.
Nancy A RigottiDepartment of Medicine, Harvard Medical School, Boston, Massachusetts.
Douglas E LevyDepartment of Medicine, Harvard Medical School, Boston, Massachusetts.

Funding

Assessing the impact of vaping control policies at the school, local and state levelsR01DA054935 · NIDA · MASSACHUSETTS GENERAL HOSPITAL · PI Douglas Levy · 2022 to 2026
$3.8M
NIDA NIH HHS R01 DA054935
6 · The paper itself

Abstract

Importance: Seven states have policies restricting the sale of flavored e-cigarettes. Limited evidence exists regarding these policies' association with the use of tobacco products across age groups. Objective: To evaluate associations of e-cigarette flavor restriction policies with e-cigarette and cigarette use by age group over multiple years. Design, Setting, and Participants: In this cross-sectional study, annual state-level prevalences of e-cigarette and cigarette use in the US between 2015 and 2023 were separately estimated among youths (high school age) using data from the Youth Risk Behavior Survey (YRBS) and young adults (ages 18-24 years) and adults (ages ≥25 years) using the Behavioral Risk Factor Surveillance System (BRFSS). Six policy states had multiple years of postpolicy data available; other states were control states. Associations between policy and prevalence of e-cigarette and cigarette use in each postpolicy year were estimated annually using difference-in-differences analysis, setting 2019 as the prepolicy year and 2020 to 2023 as postpolicy years. Exposure: Statewide policy restricting sales of non-tobacco flavored e-cigarettes. Main Outcomes and Measures: State annual prevalence of past 30-day (YRBS) and current (BRFSS) e-cigarette and cigarette use. Results: Prevalence data were obtained for 186 (YRBS) and 386 (BRFSS) state-years for e-cigarettes and 191 (YRBS) and 456 (BRFSS) state-years for cigarettes. In recent years, e-cigarette use prevalence decreased among youths (eg, the change in mean prevalence from 2019 to 2023 was 24.1% to 14.0% for policy states and 24.6% to 17.2% for control states) but increased in control states among young adults (eg, mean prevalence, 17.0% in 2019 to 20.4% in 2023). Cigarette use prevalence decreased in policy and control states, although policy states exhibited lower prepolicy prevalence and attenuated postpolicy decreases (eg, mean prevalence, 6.7% in 2019 to 3.8% in 2023 among young adults) relative to control states (eg, mean prevalence, 12.1% in 2019 to 6.3% in 2023 among young adults). Flavor policies were associated with reduced e-cigarette use among young adults in 2022 (average treatment effect among the treated [ATT], -6.7 percentage points; 95% CI, -1.3 to -12.1 percentage points) and adults aged 25 years or older in 2023 (ATT, -1.2 percentage points; 95% CI, -2.0 to -0.4 percentage points) and increased cigarette use among youths in 2021 (ATT, 1.8 percentage points; 95% CI, 0.7 to 2.9 percentage points) and young adults in 2021 (ATT, 3.7 percentage points; 95% CI, 2.2 to 5.2 percentage points), 2022 (ATT, 2.7 percentage points; 95% CI, 1.4 to 4.1 percentage points), and 2023 (ATT, 3.2 percentage points; 95% CI, 0.9 to 5.5 percentage points). Conclusions and relevance: In this study, flavor restriction policies were associated with some reductions in e-cigarette use but also unintended increases in cigarette use, highlighting a need for further work evaluating potential substitution outcomes and prevention of tobacco use among youths.

Indexed as

Electronic Nicotine Delivery SystemsFlavoring AgentsTobacco ProductsVapingAdolescentAdultBehavioral Risk Factor Surveillance SystemCross-Sectional StudiesFemaleHumansMalePrevalenceUnited StatesYoung AdultFlavoring Agents

Identifiers

PMID40736731
PMCPMC12311715

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.